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YEMEN: Chewing your way to an early death

SANAA, 5 September 2010 (IRIN) - The widespread daily ritual of chewing the amphetamine-rich leaf ‘qat’ is to blame for the growing number of mouth cancers in Yemen, according to local NGO National Foundation to Support Cancer Patients.

The Foundation said the heavy use of pesticides by farmers to grow the crop, cultivated in Yemen for over 500 years, was to blame for the proliferation of cancer cases.

According to Nadeem Mohammed Saeed, head of the state-funded National Oncology Centre (NOC) in the capital Sanaa, about 30 percent of the cancer patients he sees have mouth and gum cancers - which some studies link to `qat’ as well as the heavy use of a chewing tobacco known as ‘shamma’.

“This is really a frightening figure and represents one of the world’s highest rates for mouth and gum cancer,” Saeed said.

Millions chew `qat’ in Yemen, mostly men. At the end of the workday, usually from about 3pm, tight little bundles of the mildly narcotic leaf are bought fresh, and relaxing sessions of talking and chewing begin, which can last hours.

An estimated 70 percent of households have at least one person that uses `qat’, which represents a huge and lucrative business for growers. Cultivating the shrub takes up more than 50 percent of arid Yemen’s arable land and consumes 65 percent of its precious groundwater, according Adel al-Shujaa, head of the Combating `Qat’ Damage Association, a local NGO.

The crop is not a hard-currency earner. It is officially banned in neighbouring Saudi Arabia, and with Yemen’s `qat’ consumption the highest in the region, production is mostly for local use.

Few cancer treatment options

The 56-bed NOC, the only specialist oncology hospital in Yemen, is unable to cope with the growing number of people diagnosed with cancer.

"We don't have enough beds to accommodate hundreds of cancer patients coming from all across the nation,” said Jamal al-Azab, a doctor at the centre. NOC has a waiting list of 300 patients, and "too many patients stop frequenting the centre after they fail to find unoccupied beds," he added.

"The centre's monthly funding is enough for the treatment of 200 cases, but we receive some 400-450 cases per month," said Saeed.

Saeed’s deputy, Munif Ahmad Saleh, noted that the World Health Organization recommends there should be one oncology centre for one million people, "but in Yemen we have only one centre for 23 million people".

Reluctance to give up

Given the apparent link between pesticide-contaminated `qat’ and cancer, perhaps Yemenis are starting to rethink their addiction to the bitter green leaf?

“I cannot imagine life without it,” Muhammed, a taxi driver in his late 20s, told IRIN. “It is everything to me. It is like a father, mother and everything else… [Without it] it would be very difficult to work; I wouldn’t be able to concentrate,” he said, chewing as he fought his way through heavy traffic in central Sanaa.

Ahmed, another taxi driver, said: “I start chewing in the morning to stay alert and awake the whole day without feeling a need for a nap. I work 24 hours and then rest for a couple of days. `Qat’ makes that possible… Why should I think of quitting it? It gives me concentration and money for my family - no way.”

IRIN interviewed men at a `qat’-chewing session in a private house in Sanaa to ask them whether they could contemplate quitting.

"I cannot," said Ali al-Faqeeh, one of more than 20 people present, adding that if he stopped chewing he would be lethargic or get a fever. “Cancer also exists in many other countries where there is no `qat’," he added.

Ahmad Ali, a military officer, was fatalistic: "If you have cancer, it is caused by divine destiny," adding that the government tried to ban `qat’ use in the military, but "failed”.